OSCE Neuro Examine Cranial Nerves 5 and 7
Washes hands, appropriate dress and grooming. Introduces self and asks for consent * Hello my name is [Medical Student] and I'm a first year medical student at [Medical School], can I please get your full name and age please? * Mr. Doe, today my attending physician has asked me to do examination of your Cranial Nerves, do I have your permission? Explains procedure to patient, positions and drapes * Today examination involves me touching various parts of your face, are you comfortable with that? * I just want to remind you that anything we find will be confidential. * Is there anything you need before we begin? Test light touch in the three branches of the trigeminal nerve and comments on findings. Describe how to test for the corneal reflex * I'm going to be touching you in difference places with this cotton, please close your eyes and say "yes" whenever you feel the touch. * '''Ophthalmic Nerve Tes'''t: ** *Touch the cotton to the patient's forehead; repeat on the opposite side.* * '''Maxillary Nerve Test''': ** *Touch the cotton to the patient's upper cheek; repeat on the other side.* * '''Mandibular Nerve Test''': ** *Touch the cotton to the patient's chin; repeat on the other side.* * The patient was able to feel the cotton in all areas. * If the patient had isolated facial sensory loss, this could suggest '''trigeminal neuralgia'''. * If the patient had '''ipsilateral''' ''face'' and '''contralateral''' ''body'' sensory loss, this could suggest a '''stroke''' at the ''brainstem''. * I would like to take this time to talk about the corneal reflex. * This test is performed by approaching the patient from the side and touching the '''cornea''' (pupil+iris) of their eye with ''cotton''. ** '''Blinking''' or tearing is the '''normal''' corneal reflex and suggest that Cranial Nerve 5 and 7 is intact. ** '''No''' '''blinking''' suggest ''damage'' to Cranial Nerve 5 or 7. Test strength of the muscles of mastication and comment on findings * Mr. Doe, I'm now going to test your chewing muscles. ** *Palpate both mastication muscle* *** Please clench your teeth for me. ** *Palpate masseter muscles* *** Please clench your teeth again. * Both the temporal and masseter muscles strength felt normal. ** If I were to feel '''unilateral''' weakness this, could suggest a '''pontine lesion'''. ** If I were to feel '''bilateral''' weakness, this could suggest '''cerebral hemisphere disease'''. Test jaw jerk and comment on findings * Mr. Doe, can you please move your jaw from side to side please? * The patient was able to move their jaw from side to side. * Difficulty moving from side to side could suggest '''pterygoid muscle weakness'''. Inspects the face for evidence of CN 7 paralysis and explains the different findings for a central versus a peripheral lesion * I do not see any '''lip drooling''' which can suggest a '''central lesion '''which is associated with paralysis of only the lower face. * Lip drooling along with trouble closing the '''eye''', '''flat''' '''nasolabial''' '''fold''', and '''no''' '''forehead''' '''wrinkling''' can suggest a '''peripheral lesion'''. Test strength of muscles innervated by the facial nerve including eye closure, cheek puffing, smile, and wrinkling of forehead and comment on findings * Mr Doe, I'm now going to test the muscles of your face. ** Please raise both eyebrows. ** Please frown. ** Please close both eyes as tight as you can while I try to open them. ** Please show me your teeth. ** Please smile. ** Please puff out both cheeks. * The patient was able to perform all the task. * This suggest the patient does not have ''upper'' or ''lower'' face ''paralysis'' associated with '''trauma''', '''Bell's Palsy''' or '''stroke'''. * That's the end of the exam, thank you come coming in today. Knowledge question